Qualitative exploration of sociocultural determinants of health inequities of Dalit population in Dhaka City, Bangladesh

Abstract

ObjectivesIn recent years, Bangladesh has made remarkable advances in health outcomes; however, the benefits of these gains are unequally shared among citizens and population groups. Dalits (jaat sweepers), a marginalised traditional working community, have relatively poor access to healthcare services. This study sought to explore the sociopolitical and cultural factors associated with health inequalities among Dalits in an urban setting.DesignAn exploratory qualitative study design was adopted. Fourteen in-depth interviews, five focus group discussions and seven key informant interviews were conducted. The acquired data were analysed using an iterative approach which incorporated deductive and inductive methods in identifying codes and themes.SettingsThis study was conducted in two sweeper communities in Dhaka city.ParticipantsParticipants were Dalit men and women (in-depth interviews, mean age±SD 30±10; and focus group discussions), and the community leaders and non-governmental organisation workers (key informant interviews).ResultsThe health status of members of these Dalit groups is determined by an array of social, economic and political factors. Dalits (untouchables) are typically considered to fall outside the caste-based social structure and existing vulnerabilities are embedded and reinforced by this identity. Dalits’ experience of precarious access to healthcare or poor healthcare is an important manifestation of these inequalities and has implications for the economic and social life of Dalit populations living together in geographically constrained spaces.ConclusionsThe provision of clinical healthcare services alone is insufficient to mitigate the negative effects of discriminations and to improve the health status of Dalits. A better understanding of the precise influences of sociocultural determinants of health inequalities is needed, together with the identification of the strategies and programmes needed to address these determinants with the aim of developing more inclusive health service delivery systems.

Caste Exclusion and Health Discrimination in South Asia: A Systematic Review

“…Discrimination in occupation, prolonged poverty, and social stigma reduces their opportunity to access labor market in equal terms with non-Dalits; they also fail to get into occupations that did not conform to their low social and political status. 40 Although law and policies have been introduced, socioeconomic hierarchies based on caste persist in South Asia. 41 Dalit women are doubly disadvantaged due to their lowcaste status as well as the lower status of women in Hindu society.…”

Socio-demographic characteristics, lifestyle factors, multi-morbid conditions and depressive symptoms among Nepalese older adults

“…Emerging evidence shows that Dalits experience a wide range of social and economic discrimination at various levels (poor living conditions, poor nutrition, low literacy, poor empowerment, poor access to health services and stigmatization) and this results in a severe form of health inequalities [15,33,34]. Stigmatization is pervasive and worsens psychological stress for those in the Dalit communities [35].…”

Socio-demographic characteristics, lifestyle factors, multi-morbid conditions and depressive symptoms among Nepalese older adults

“…Emerging evidence shows that Dalits experience a wide range of social and economic discrimination at various levels (poor living conditions, poor nutrition, low literacy, poor empowerment, poor access to health services and stigmatization) and this results in a severe form of health inequalities (15,31,32). Stigmatization is pervasive and worsens psychological stress for those in the Dalit communities (33).…”